OECD_加强西班牙巴斯克地区卫生公平的社区行动（英）_107页_2mb

Summary of Community Action to Strengthen Health Equity in the Spanish Basque Country

Core Content

This report explores the role of community action in promoting health equity in the Basque Country, as part of a broader OECD initiative aimed at strengthening public health through local engagement. It outlines the current landscape of community action, the institutional framework, challenges, and recommendations for a more effective strategy.

Main Objectives

• To assess the current state of community action for health and well-being in the Basque Country.
• To identify key challenges and opportunities for enhancing community engagement.
• To provide recommendations for developing a comprehensive and sustainable strategy for community action.

Key Points

1. Community Action for Health and Well-being

• Definition: Community action refers to initiatives that involve communities in the design, implementation, and evaluation of health-related activities. It includes both community participation (involvement in decision-making) and community empowerment (increasing control over health determinants).
• Scope: It encompasses a wide range of target groups, including young people, the elderly, women, individuals with substance use disorders, and immigrants.
• Digital Communities: With increasing digitalisation, the concept of community can also include virtual communities linked by shared interests or social networks.

2. Institutional Setup

• The Department of Health of the Basque Country (DHBC) has a complex institutional structure with multiple directorates and units involved in health promotion and community action.
• The Directorate of Public Health and Addictions (DPHA) is primarily responsible for promoting community action, particularly through the Health Promotion unit.
• Other units within the DHBC and Osakidetza (healthcare services) also engage in community action initiatives.
• Third sector and private entities also contribute to community health and well-being.

3. Challenges Identified

• Fragmentation: There is no central focal point within the DHBC for community action, leading to a lack of coordination.
• Limited Resources: Only 1.3% of the DHBC budget is allocated to community health promotion, with less than 10% going to grants for local initiatives.
• Human Resources: Staff working on community action often lack the necessary skills and training, and many are not based in the areas where fieldwork occurs.
• Monitoring and Evaluation: These processes are inconsistent across different sectors, with only some third-sector organisations engaging in regular evaluation.
• Inclusion Gaps: Excluded groups are rarely represented in local networks, limiting the inclusivity of community initiatives.

4. Recommendations

The OECD recommends a three-pronged strategy to strengthen community action in the Basque Country:

• Strategic Line 1: Developing a Governance Structure

• Ensure sufficient personnel to support community action at the local level.
• Implement education and training programs focused on community action.
• Diversify the workforce profile within the DHBC.
• Strengthen local coordination structures and involve communities in these processes.

• Strategic Line 2: Promoting Community Action at the Local Level

• Enhance the role of health promotion within the DHBC.
• Encourage municipalities to develop programs for health protection, promotion, and addiction prevention.
• Create a network of local entities to support community action.
• Build a knowledge-sharing database and facilitate access to public spaces.
• Develop new community-friendly public spaces.

• Strategic Line 3: Fostering Awareness and Policy Evaluation

• Create a dissemination plan for the strategy and a platform for citizen input.
• Promote research on community action within Basque academic institutions.
• Develop a self-evaluation tool for local communities.
• Establish indicators to monitor and evaluate the impact of community initiatives.
• Evaluate the implementation of the strategy regularly.

Conclusion

The report highlights that while community action is growing in the Basque Country, it remains fragmented and under-resourced. Strengthening institutional coordination, increasing investment, and improving the skills and inclusivity of community initiatives are essential to achieving health equity and improving well-being. The OECD's recommendations provide a roadmap for the DHBC to develop a more structured, inclusive, and sustainable approach to community action.

Key Figures and Tables

• Figure 1.1: Main causes of mortality across OECD countries.
• Figure 1.2: Prevalence of good health and symptoms of anxiety and depression in the Basque Country.
• Figure 1.3: Health status by socio-economic group.
• Figure 3.1: Organisational structure of the DHBC.
• Figure 4.1: DHBC budget structure by programme (2022).
• Figure 4.2: Budget lines for public health and addictions (2017–2022).
• Figure 4.3: Number of projects and funding sources.
• Figure 6.1–6.8: Distribution of respondents, initiatives, and funding sources.
• Figure 7.1–7.11: Usage of guides, tools for participation, and challenges in community action.
• Table 3.1–3.2: Grants offered by the Health Promotion and Addictions units.
• Table 4.1–4.3: DHBC and Osakidetza budget and staffing details.
• Table 8.1: Summary of OECD recommendations.

References and Notes

• The report is part of a larger OECD project on community participatory processes for health equity.
• It is funded by the European Union via the Technical Support Instrument.
• The findings are based on a fact-finding mission, online interviews, and questionnaires from various stakeholders.
• The report acknowledges the contributions of the Basque Country's Department of Health, third-sector organisations, and academic researchers.